The Centre

Dalam Bahagian 1 laporan kajian kesejahteraan mental yang diterbitkan pada April 28, kami mendapati bahawa lebih 50% dari responden kaji selidik melaporkan mengalami kesan emosi negatif. Hasi kajian menggambarkan bahawa keadaan tempat tinggal yang merangkumi kepadatan isi rumah dan jenis kediaman  semasa tempoh Perintah Kawalan Pergerakan (PKP) mempengaruhi kadar kesejahteraan mental rakyat Malaysia.

Dalam Bahagian 2, kami mengkaji bagaimana perubahan dalam pekerjaan dan status kewangan sepanjang tempoh PKP mempengaruhi kadar kesejahteraan mental. Seperti dalam Bahagian 1, tahap kesejahteraan mental diukur menggunakan kaji selidik DASS-21. (Untuk maklumat lanjut tentang cara penerapan kaji selidik DASS-21 dan metodologi kajian secara keseluruhan, sila rujuk Bahagian 1).

Sampel

Analisa Bahagian 2 kajian ini menggunakan sub-sampel 720 responden daripada keseluruhan 1084 maklum balas yang dikumpulkan. Ini adalah kerana terdapat responden yang memberikan data tidak lengkap atau tidak teratur tentang pendapatan isi rumah. Penyisihan respons yang bermasalah membolehkan kami memberikan gambaran yang lebih tepat tentang kekangan kewangan yang dihadapi oleh responden.

Pecahan demografi sub-sampel adalah hampir sama dengan keseluruhan sampel (sila rujuk Bahagian 1): 59% responden dari kawasan bandar, dengan 70% dari Selangor dan Kuala Lumpur. 63% dari responden adalah wanita, dengan 82% mewakili Melayu/Bumiputera dan 42% dalam lingkungan umur 24-34. Selain itu, responden secara purata mempunyai tiga orang tanggungan kewangan.

Seperti dalam Bahagian 1, maklum balas tidak mewakili sampel berstrata nasional. Kelaziman dalam kaji selidik, masalah responden terkurang atau terlebih memberi maklum balas boleh berlaku – ini telah dikenalpasti dan jawapan di luar julat tidak dimasukkan di dalam kajian. Dapatan kajian ini perlu ditafsir dengan mengambil kira kekangan-kekangan yang disebutkan di atas.

Bagaimana pendapatan isi rumah telah berubah sepanjang PKP?

Penurunan pendapatan secara keseluruhan

Kami meminta responden melaporkan pendapatan isi rumah sebelum dan semasa tempoh PKP. Secara keseluruhan, purata pendapatan isi rumah responden sebelum dan semasa tempoh PKP adalah sebanyak RM8,790 dan RM7,773. (Jumlah ini adalah lebih tinggi dari purata kebangsaan, tetapi mewakili tumpuan responden kami di Selangor dan Kuala Lumpur dimana pendapatan purata isi rumah adalah lebih tinggi).

Dalam Bahagian 1 kajian ini, kami meneliti keadaan tempat tinggal dan jenis isi rumah. Dengan mengklasifikasikan pendapatan berdasarkan jenis isi rumah (Rajah 1a), dapat dilihat perbezaan tingkat purata pendapatan isi rumah berdasarkan jenis kediaman: isi rumah yang berpendapatan lebih tinggi lazimnya tinggal di bungalow/rumah berkembar atau apartment dan kondominium, sementara mereka dengan pendapatan rendah menetap di perumahan kos rendah. Secara purata perbezaan pendapatan isi rumah sebelum dan semasa PKP adalah sebanyak RM1,0008.

Rajah 1a: Pendapatan Purata Isi Rumah Sebelum dan Semasa PKP berdasarkan Jenis Kediaman

Kami juga mengklasifikasikan pendapatan sebelum dan semasa PKP berdasarkan jenis pekerjaan (Rajah 1b). Pekerja sambilan, pekerja sendiri dan pemilik perniagaan mengalami kemerosotan pendapatan yang paling ketara. Pekerja sambilan merupakan golongan yang paling terkesan dengan purata pendapatan mereka berkurangan sebanyak 50%, diikuti oleh pemilik perniagaan yang melaporkan pendapatan mereka merosot sebanyak 48%. Pekerja sepenuh masa merupakan golongan yang paling stabil diantara semua jenis pekerjaan, dengan penurunan pendapatan 3%.

Rajah 1b: Pendapatan Purata Isi Rumah Sebelum dan Semasa PKP berdasarkan Jenis Pekerjaan

Pendapatan turun, kadar kesejahteraan mental negatif meningkat

Rajah 2a-2c melaporkan bagaimana perubahan pendapatan memberi kesan kepada kesejahteraan mental. Tidak menghairankan, 54% dari golongan yang melaporkan penurunan pendapatan turut melaporkan mengalami kemurungan, manakala 40% melaporkan mengalami keresahan dan tekanan. Lebih kurang 25% melaporkan mengalami kemurungan serta keresahan di kadar teruk dan amat teruk, sementara 18% melaporkan mengalami tekanan di kadar yang sama.

Sebaliknya, mereka yang melaporkan peningkatan pendapatan isi rumah mengalami kadar kesejahteraan mental normal, kecuali kemurungan dimana 43% melaporkan mengalami tanda-tanda kemurungan ringan atau sederhana.

Rajah 2a: Perubahan pendapatan dan kesan terhadap tahap kemurungan

Rajah 2b: Perubahan pendapatan dan kesan terhadap tahap keresahan

Rajah 2c: Perubahan pendapatan dan kesan terhadap tahap tekanan

Kesejahteraan Mental dan Status Pekerjaan

Kadar kesejahteraan mental paling negatif di kalangan pelajar dan penganggur

Rajah 3a-3c menunjukkan pelajar dan penganggur mengalami kadar kesejahteraan mental paling negatif merentasi ketiga-tiga dimensi, diikuti oleh pekerja sambilan di tempat ketiga.

Pekerja sambilan dan penganggur melaporkan mengalami kadar kesejahteraan mental negatif di peringkat teruk. 27% dan 38% dari pekerja sambilan serta penganggur melaporkan mengalami tanda-tanda kemurungan di peringkat amat teruk dan teruk, berbanding 20% atau kurang oleh golongan lain (selain pelajar). Tren yang hampir sama turut dapat dilihat pada dimensi keresahan, di mana kedua-dua golongan pekerja sambilan dan penganggur melaporkan mengalami keresahan amat teruk dan teruk di kadar 34% dan 29%.

Sementara itu, 62% dan 58% pelajar melaporkan mengalami tanda-tanda keresahan dan kemurungan, manakala 40% melaporkan mereka mengalami tekanan. Kadar yang tinggi ini selari dengan penemuan kami di Bahagian 1 dimana ramai individu dalam golongan umur 18-24 – yang 90% merupakan pelajar – melaporkan mengalami emosi negatif, berbanding peringkat umur yang lain. Tinjauan seterusnya mendapati bahawa ini mungkin didorong oleh isu-isu berkaitan pekerjaan: maklumbalas pelajar kepada soalan terbuka (subjektif) tentang kerisauan utama mereka pasca-PKP sebahagian besar berkisar isu status mereka sebagai graduan baru di masa ketidaktentuan ekonomi. Ini turut selari dengan amaran Persekutuan Majikan Malaysia (MEF) kepada graduan tentang pasaran kerjaya yang dijangka suram pasca-PKP.

Pesara mengalami kadar kesejahteraan mental negatif terendah diantara semua golongan, dengan rata-rata hanya melaporkan tanda-tanda kesejahteraan mental negatif di peringkat sederhana atau ringan.

Rajah 3a: Perbezaan dalam tahap kemurungan berdasarkan jenis pekerjaan

Rajah 3b: Perbezaan dalam tahap keresahan berdasarkan jenis pekerjaan

Rajah 3c: Perbezaan dalam tahap tekanan berdasarkan jenis pekerjaan

Perubahan status pekerjaan, ramai yang tidak dapat bekerja semasa PKP

Salah satu kesan negatif PKP ialah kekangan terhadap aktiviti ekonomi. Ramai rakyat Malaysia yang bekerja sebelum tempoh PKP mengalami perubahan status pekerjaan mereka sepanjang tempoh PKP. (Sejak kajian mula dijalankan, Malaysia telah beralih kepada PKP Bersyarat dengan pembukaan sektor-sektor ekonomi tertentu).

Bagi mereka yang bekerja sebelum tempoh PKP, pemilik perniagaan dan mereka yang bekerja sendiri mengalami perubahan paling ketara, dengan 60% melaporkan mereka tidak dapat bekerja sepanjang tempoh PKP.

Pekerja sambilan pula paling banyak mengalami perubahan, dengan 7% dibuang kerja, 20% terpaksa mengambil cuti tanpa gaji dan 20% pula dipotong gaji.

Pekerja sepenuh masa dilihat berada dalam keadaan paling stabil dengan 88% tidak mengalami apa-apa perubahan status pekerjaan.

Rajah 4: Bagaimana status pekerjaan berubah semasa PKP

Golongan dipecat paling teruk terkesan, diikuti oleh golongan mengambil cuti tanpa gaji

Rajah 5a-5c menggambarkan sekurang-kurangnya 30% responden melangkaui semua status pekerjaan semasa tempoh PKP melaporkan mengalami emosi negatif. Mereka yang mengambil cuti tanpa gaji melaporkan kadar kemurungan tertinggi (68%) manakala golongan yang dipecat melaporkan kadar keresahan dan tekanan tertinggi (masing-masing 62%).

Di antara golongan yang dipecat, 38% melaporkan kadar kemurungan dan keresahan yang amat teruk, manakala 25% melaporkan perasaan tekanan yang amat teruk. Di kalangan mereka yang bercuti tanpa gaji, 48% melaporkan keresahan yang teruk dan amat teruk, manakala 32% melaporkan kadar kemurungan yang teruk dan amat teruk. Walau bagaimanapun, hanya 5% melaporkan kadar tekanan yang amat teruk.

Tidak menghairankan, mereka yang melaporkan bahawa tiada perubahan terhadap status pekerjaan, turut melaporkan mengalami kadar emosi negatif terendah.

Rajah 5a: Perbezaan dalam tahap kemurungan berdasarkan status pekerjaan

Rajah 5b: Perbezaan dalam tahap keresahan berdasarkan status pekerjaan

Rajah 5c: Perbezaan dalam tahap tekanan berdasarkan status pekerjaan

Kebimbangan jangka pendek dan jangka panjang

Ketidaktentuan keadaan kewangan pasca-PKP

Di akhir Bahagian 1, kami melaporkan ramai responden bimbang mengenai kesihatan serta keselamatan diri dan orang-orang tersayang. 47% responden menyatakan mereka bimbang mengenai keadaan kewangan semasa tempoh PKP berbanding 56% yang bimbang tentang tentang keadaan kewangan pasca-PKP.

Rajah 6: Kerisauan utama semasa Perintah Kawalan Pergerakan (PKP)

Kami meminta para responden untuk menyatakan maksimum tiga kebimbangan kewangan utama bagi dua tempoh masa: di waktu kajian dijalankan semasa tempoh PKP, dan kebimbangan mereka di masa hadapan setelah PKP tamat. Selari dengan kebimbangan mengenai keadaan kewangan secara keseluruhan seperti dibincangkan di atas, responden mengenalpasti lebih banyak kebimbangan kewangan di masa hadapan (pasca-PKP) berbanding semasa dalam tempoh PKP.

Dari Rajah 7, kebimbangan kewangan utama yang dikenalpasti responden adalah tidak mampu menanggung kos kecemasan perubatan, tidak mampu menanggung keperluan isi rumah serta tidak mampu membayar bil, pinjaman serta sewa atau tunggakan. Lebih ramai responden risau akan hal kecemasan perubatan semasa tempoh PKP berbanding selepas. Situasi ini terbalik bagi kebimbangan utama yang lain: walaupun terdapat kebimbangan mengenai kebolehan menanggung keluarga, membayar bil, pinjaman serta sewasepanjang tempoh PKP, lebih ramai responden yang risau tentang hal-hal ini pasca-PKP.

Rajah 7: Kebimbangan kewangan utama semasa dan selepas PKP

Lanskap Sokongan Kesihatan Mental Semasa

Terdapat peluang memperbaiki pendekatan terkini Malaysia terhadap sokongan kesihatan mental. Isu semasa berkaitan kesihatan mental dapat dikaitkan dengan kekurangan penawaran jawatan berkaitan kesihatan mental, dan hasilnya, kekurangan sumber bagi memenuhi keperluan sokongan kesihatan mental. Data terkini dari Kementerian Kesihatan menyatakan bahawa di Malaysia, terdapat 0.5 pakar psikiatri bagi setiap 100,000 individu,  manakala terdapat 0.21 ahli psikologi klinikal bagi setiap 100,000 individu. Ini lebih rendah dari cadangan Pertubuhan Kesihatan Sedunia (WHO) agar terdapat 1 pakar psikiatri bagi setiap 100,000 individu, serta median global 1.1 pakar psikologi bagi setiap 100,000 individu.

Selain dari kekurangan kepakaran, juga terdapat stigma berkaitan kesihatan mental dan gangguan mental. Walaupun terdapat usaha meningkatkan kesedaran terhadap perkara ini , ramai yang masih kurang faham tentang isu-isu berkaitan kesihatan mental. Kekeliruan tentang masalah kesihatan mental boleh membawa kepada diskriminasi, sama ada secara peribadi atau profesional, serta keengganan untuk pesakit mendapatkan bantuan. Walau bagaimanpun, semasa PKP, kelihatan ramai rakyat yang menghubungi talian bantuan atau sokongan kesihatan mental yang ditawarkan oleh Kementerian Kesihatan serta NGO-NGO. Ini mungkin menandakan adanya peningkatan keterbukaan rakyat Malaysia mendapatkan dan menerima sokongan kesihatan mental.

Namun begitu, oleh kerana infrastruktur bantuan kesihatan mental awam masih terhad, mendapatkan bantuan kesihatan mental boleh melibatkan kos yang tinggi. Kos bantuan kesihatan mental atau terapi swasta boleh mencapai RM250 setiap sesi. Juga ada kekurangan dari segi perlindungan insurans menyeluruh bagi kesihatan mental di Malaysia, dengan hanya beberapa syarikat insurans yang menawarkan perlindungan, dan dikalangan mereka, hanya untuk kes penyakit mental yang amat teruk dan tanpa gejala sedia ada.

Pertimbangan dasar

Mercy Malaysia menjangkakan peningkatan panggilan kepada talian bantuan kesihatan mental berkaitan isu psikologi melangkaui tempoh PKP. Mengambil kira jangkaan pertambahan kadar pengangguran dan ketidaktentuan ekonomi, mungkin kita bakal melihat lebih ramai rakyat Malaysia mengalami keadaan kesejahteraan mental negatif ketika bergelut dengan kesan kejatuhan ekonomi akibat COVID-19. Walaupun pakej Bantuan Prihatin Nasional telah diumumkan oleh kerajaan dengan tujuan membantu mengurangkan kesan kewangan, usaha turut perlu ditumpukan ke arah menyokong kesejahteraan mental rakyat Malaysia.

Apakah langkah-langkah yang boleh diambil untuk menambahbaik sokongan kesihatan mental kita? Pertama, ada keperluan segera untuk menangani isu kekurangan pakar kesihatan mental – peluang pekerjaan dan latihan bagi kerjaya berkaitan kesihatan mental perlu ditambah melebihi kadar sedia ada. Ini meliputi membuka peluang-peluang pekerjaan berkaitan kesihatan mental, dan juga memperbaiki akses rakyat kepada program sokongan kesihatan mental – sebagai contoh Program Minda Sihat di sekolah-sekolah.

Kedua, hasil kajian kami mendapati bahawa penghuni rumah kos rendah serta individu yang berada dalam keadaan kewangan runcing, mempunyai kebarangkalian lebih tinggi untuk mengalami kesan kesejahteraan mental negatif. Mengambil kira bahawa usaha ke arah menambah peluang pekerjaan dan latihan berkaitan kesihatan mental biasanya datang dari institusi kesihatan – kami berpendapat bahawa pendekatan komuniti dapat membantu meringankan serta mengatasi jurang kesedaran kesihatan mental dan memberi sokongan yang diperlukan oleh komuniti ini. Individu yang dikenalpasti dalam sesebuah komuniti boleh bekerjasama dengan pakar kesihatan mental bagi meningkatkan kesedaran tentang kesihatan mental di kalangan komuniti mereka serta mencadangkan sistem sokongan yang diperlukan.

Ketiga, berdasarkan kajian kami, golongan dengan status pekerjaan yang tidak menentu mengalami lebih kadar emosi negatif, dan lebih berisiko untuk menerima kesan daripada kejatuhan ekonomi. Peningkatan sokongan kesihatan mental, atau bantuan kewangan untuk membolehkan mereka mendapatkan sokongan kesihatan mental, boleh membantu mereka untuk menghadapi cabaran ekonomi mendatang. Selari dengan akses yang lebih mudah kepada kesihatan mental seperti dibincangkan di atas, kami melihat peluang sokongan lebih menyeluruh untuk dikembangkan sebagai pelengkap, merangkumi program seperti kaunseling hutang.

Turut terdapat peluang untuk mengkaji semula perlindungan insurans untuk kesihatan mental. Walaupun kami sedar adalah sukar untuk mengukur kadar masalah mental (masalah sama turut dihadapi di Amerika Syarikat), lebih banyak insentif perlu diberikan kepada syarikat insurans supaya dapat melihat isu kesihatan mental secara  menyeluruh. Ini dapat dilakukan selaras dengan peningkatan kesedaran serta menggalakkan majikan untuk memberikan lebih banyak sokongan kesihatan mental kepada pekerja-pekerja dalam tempoh mencabar ini.

Kesimpulan

Kajian ini telah mendapati bahawa pemilik perniagaan serta pekerja sendiri mengalami kesan pengurangan pendapatan drastik sepanjang tempoh PKP, manakala pekerja sambilan serta penganggur melaporkan mengalami kadar kesejahteraan mental negatif yang tertinggi. Mereka yang dipecat ataupun terpaksa mengambil cuti tanpa gaji turut mengalami kadar kesejahteraan mental negatif tertinggi. Tidak menghairankan, golongan-golongan ini merupakan yang paling rentan dimasa ketidaktentuan ekonomi.

Walaupun mengambil kira kepentingan isu ini, perbincangan tentang kesihatan mental hanya mendapat perhatian dalam beberapa tahun terakhir ini. Covid-19 dan PKP, walaupun telah memperburuk kadar kesejahteraan mental, juga memberikan kita kesedaran bahawa apa yang kita saksikan hanyalah episod terkini dalam rentetan berpanjangan masalah kesejahteraan dan kesihatan mental rakyat. Pada Mac, lebih 610,000 rakyat Malaysia telah dibuang kerja akibat perusahaan-perusahaan berhadapan kerugian yang serius sepanjang tempoh PKP. Angka ini dijangka akan terus meningkat dalam bulan-bulan akan datang, tatkala kita berhadapan dengan kejatuhan ekonomi dunia.

Situasi semasa telah memanggil kita untuk memastikan penambahbaikan sistem sokongan kesihatan mental di Malaysia. Walaupun kerajaan telah mengumumkan skim perlindungan kewangan bagi golongan-golongan terbabit, kami mendapati bahawa kesan PKP terhadap kesejahteraan mental melangkaui penyelesaian krisis perubatan awam ini. Langkah selanjutnya, melampaui memupuk kesedaran, adalah untuk melakukan perubahan secara sistematik dan menterjemahkan maklum balas tentang keadaan kesihatan mental ke dalam bentuk polisi yang berkesan.

In Part 1 of our mental well-being study published on 28 April, we found that over 50% of the survey respondents reported experiencing negative emotions. Immediate living conditions during the Movement Control Order (MCO) such as the number of occupants in a household and the type of home people lived in affected the mental well-being of Malaysians.

In Part 2, we explore how changes in employment and income during the MCO affect mental well-being as measured using the DASS-21 questionnaire. While we explore mental well-being, our study does not diagnose depression, anxiety and stress as a medical condition. For more details on how the DASS-21 questionnaire was applied and the study’s overall methodology, please refer to Part 1.

Sample

For the analysis in Part 2, we used a sub-sample of 720 respondents from the 1084 responses that we initially collected. The reduction in observations were due to incomplete and irregular household income related data provided by respondents. The elimination of problematic observations allowed us to provide a more accurate picture of the current financial predicaments faced by our respondents.

The demographic breakdown of the sub-sample was similar to the overall sample (which is available in Part 1): 59% of our respondents were living in urban areas, with 70% coming from Selangor and Kuala Lumpur. 63% of the respondents were female, 82% were Malay/Bumiputera and 42% were between the ages of 24-34. Additionally, the average respondent also reported having three financial dependents.

As in Part 1, our responses do not represent a nationally stratified sample. With surveys, under and over reporting can occur, and outliers have been omitted. The results should be viewed with these limitations in mind.

How have household incomes changed during the MCO?

Income reductions all round

We asked respondents to report their household income before and during the MCO period.  Overall, the average reported household income before and during the MCO was RM8,790 and RM7,773 respectively. (This figure is higher than the national average, but is reflective of the concentration of our respondents in Selangor and KL where average household income is higher).

In Part 1 of the study, we examined living conditions and household types. Grouping income by household type (Figure 1a), we observe that levels of average household income differ by housing type, with more affluent households living in bungalows/semi-detached housing or apartments and condominiums, and those with the lowest income levels living in low cost housing. On average the difference between income before and during the MCO was RM1,008.

Figure 1a: Average Household Income Before and During MCO by Housing Type

We also analysed income by different employment types. The difference in average household income before and during the MCO here is more stark (Figure 1b). Part time employees, the self-employed and business owners saw their income reduced by over half. Part-time employees were the most affected, with their average pay reduced by 50%, closely followed by business-owners who reported a 48% reduction in income. Full-time employees were the most stable among all employment types, reporting a 3% income reduction.

Figure 1b: Average Household Income Before and During MCO by Employment Type

A decrease in income, an increase in negative mental well-being

Figures 2a-2c report how changes in income affected mental well-being. Unsurprisingly, 54% of of those who reported a decrease in income also reported experiencing depression and approximately 40% reported experiencing anxiety and stress. Approximately a quarter reported experiencing severe and extremely severe depression and anxiety, with 18% reporting similar levels of stress. 

Conversely, those who reported an income increase experienced normal levels of overall mental well-being, apart from depression, where 43% of respondents reported experiencing mild to moderate signs of depression.

Figure 2a: Changes in income and its effects on depression levels

Figure 2b: Changes in income and its effects on anxiety levels

Figure 2c: Changes in income and its effects on stress levels

Mental Well-Being and Employment

Students and the unemployed experiencing most negative mental well-being

Figures 3a-3c show that students and the unemployed consistently experience the most negative mental well-being across all three dimensions, with part-time employees in third place.

Part-time employees and the unemployed reported experiencing higher levels of severe negative mental well-being. 27% and 38% of part-time employees and the unemployed respectively reported experiencing extremely severe and severe signs of depression – compared to 20% or less in other groups (except students).  A similar trend emerges in the anxiety dimension, with both part-time employees and the unemployed respectively experiencing 34% and 29% of extremely severe and severe anxiety.

Meanwhile, 62% and 58% of students reported experiencing signs of anxiety and depression respectively, with 40% reporting stress. These high percentages correspond with our findings in Part 1 where those between ages 18-24 were more likely to report experiencing negatively emotions compared to other age groups – 90% of the 18-24 year olds in the sample were students. Qualitative data suggests that this may be driven by employment issues: student responses to an open-ended question asking what their main worries post-MCO were largely identified being fresh graduates at a time of economic uncertainty as a major concern. Indeed, the Malaysian Employers Federation warned fresh graduates of a bleak job market post-MCO due to business taking cost-cutting measures.

Retirees experience the least negative mental well-being across the board, typically only reporting moderate or mild signals of negative mental well-being.

Figure 3a: Differences in reported levels of depression by employment type

Figure 3b: Differences in reported levels of anxiety by employment type

Figure 3c: Differences in reported levels of stress by employment type

Change in employment status, many unable to work during MCO

The MCO meant limitations on economic activity and many Malaysians in the workforce prior to the MCO experienced a change in their work status during the MCO. (Since the study was undertaken, Malaysia has now moved to a conditional MCO with certain economic sectors reopening).

Of those in employ before the MCO, business owners and the self-employed experienced the most change, with approximately 60% reporting they were unable to work during the MCO period. Part-time employees experienced the highest levels of retrenchment (7%). Additionally, they also form the highest level of those going on unpaid leave and reduced pay, both at 20%.

Full-time employees appear to be the most stable out of all job types, with 88% of them experiencing no change. 

Figure 4: How employment status has changed during the MCO

Retrenched severely affected, followed by those on unpaid leave

In Figures 5a-5c, at least 30% of respondents across all employment statuses during the MCO reported experiencing some negative emotions.  Those on unpaid leave reported the highest level of depression (68%) while those who were retrenched reported the highest levels of anxiety and stress (62% respectively). 

Among the retrenched, 38% reported extremely severe depression and anxiety, and 25% reported extremely severe feelings of stress. Of those on unpaid leave, 48% reported experiencing severe and extremely severe anxiety and 32% reported experiencing severe and extremely severe depression. Only 5%, however, reported extremely severe levels of stress.

Unsurprisingly, those reporting no change reported experiencing the lowest levels of negative emotions.

Figure 5a: Differences in reported depression by employment status

Figure 5b: Differences in reported anxiety by employment status

Figure 5c: Differences in reported stress by employment status

Long and short-term concerns

Financial situation after MCO uncertain

At the end of Part 1, we reported that many respondents were worried about health and safety of themselves and their loved ones. 47% of respondents indicated that they were worried about their financial situation during the MCO, but 56% were worried about their financial situation after the MCO.

Figure 6: Major concerns during Movement Control Order (MCO)

We asked our respondents to indicate up to three major financial concerns at two points in time: at the point the survey was conducted during the MCO, and their future financial worries after the MCO was lifted. Consistent with their overall financial worries discussed above, respondents identified more financial concerns in the future after the MCO ended compared to during the MCO. 

From Figure 7, the major financial concerns that respondents identified were not being able to afford a medical emergency, not being able to support dependents and not being able to pay bills, loans and rent / mortgages. Consistent with the MCO being related to a public health crisis, more respondents were concerned about not being able to afford a medical emergency during the MCO compared to in the future. The situation was reversed for the other major concerns: while they were worried about these issues during the MCO, more respondents identified this as a worry after the MCO.

More respondents also reported no financial worries during the MCO compared to after the MCO, suggesting that economic uncertainty post-MCO weigh on the minds of many.

Figure 7: Major financial concerns during and after MCO

Current Mental Health Support Landscape

There is an opportunity to improve Malaysia’s current approach to mental health support. Its current issues, to some extent, can be attributed to a lack of mental health-related employment, and consequently, limited resources to meet mental health support needs. On an institutional level, the Ministry of Health’s latest numbers indicate that there are 0.5 psychiatrists to 100,000 persons, while there are 0.21 clinical psychologists to every 100,000 persons. This is below the World Health Organisation’s recommendation of 1 psychiatrist to every 100,000 persons, and the global median of 1.1 psychologists to every 100,000 persons.

On top of the lack of expertise, there is the existing stigma regarding mental health and illness. Although efforts are headway in increasing awareness of mental health, there still exists a lack of understanding towards mental health issues. This can lead to discrimination faced on both personal and professional fronts, and potential reluctance in seeking help. That said, there was an uptake in engagement with mental health support offered by the Ministry of Health and various NGOs via hotlines and messaging platforms during the MCO. This may indicate increasing awareness among Malaysians in seeking out and receiving mental health support.

Seeking help, though, can be costly. The lack of a comprehensive public-sector infrastructure for mental health may lead to those seeking help via the private sector where average prices for mental health support or therapy can cost up to RM250 per session. There is also a lack of comprehensive insurance for mental health coverage in Malaysia, with very few insurance companies offering coverage, and among those who do, only for very severe mental illness and without pre-existing conditions.

Policy Recommendations

Mercy Malaysia expects psychological-related calls to mental health support hotlines to increase beyond the MCO. Considering the projected increased unemployment and economic uncertainty, it is likely that we will see more Malaysians experiencing negative mental well-being as they struggle with the economical fallout of COVID-19. Although the government’s Prihatin stimulus packages are intended to soften the financial blow, efforts also need to focus on supporting the mental well-being of Malaysians.

What might be feasible ways forward towards improving our mental health infrastructure ? First, there is a need to address the issue of the low number of mental health experts and professionals – employment opportunities and training for mental health-related employment need to be bolstered above current levels. This includes opening up mental health related opportunities as well as making mental health support more accessible – like the Healthy Minds Programme in schools.

Second, our findings have shown that those who reside in low-cost housing are more likely to be susceptible to negative mental well-being, as well as those in precarious financial conditions. While the move to increase employment and training for mental health-related opportunities is institutional – we argue that a more community-based approach may help alleviate and overcome the gap of mental health awareness and support in these vulnerable communities. Trusted members of the community can work together with mental health professionals to increase mental health literacy in their communities and recommend appropriate support systems to promote health-seeking behaviours.

Third, based on our findings, those with precarious employment situations experience more negative emotions, and are likely to suffer most from the economic fallout. Increased mental health support or financial assistance towards accessing this may help them weather the expected economic downturn better. Following the more accessible mental health approach mentioned above, we see an opportunity for holistic support to be extended to, and complement, areas such as debt counselling.

There is also an opportunity here to rethink and expand insurance coverage for mental well-being beyond critical mental illnesses. While we appreciate that mental health difficulties are difficult to quantify (there is also a similar problem in the United States), more incentive needs to be given for insurance providers to adopt a more holistic view of mental health. This can be done in tandem with increasing awareness and incentivising employers to give more mental well-being support to their employees during this difficult time.

Conclusion

The study has revealed that business owners and the self-employed have suffered significant loss of income during the MCO, and part-time employees and the unemployed report experiencing the highest level of severe negative mental well-being. Those who were retrenched and on unpaid leave also experienced the highest level of negative mental well-being. Unsurprisingly, these are the groups most vulnerable in a time of economic uncertainty.

Despite its importance, discussion about mental health has only seen prominence in recent years. COVID-19 and the MCO, while having worsened mental well-being, has shed light on the seriousness of this issue. In March, over 610,000 Malaysians were retrenched as companies suffered financial losses over the MCO. This number is expected to rise in the coming months, as we deal with the global economic fallout.

The current situation has amplified an urgency for an improvement of mental health support in Malaysia. While financial social protection for affected groups are in place and have been announced by the government, we see the amplified mental health effects of MCO going beyond the resolution of this public health crisis. The way forward, beyond awareness, is to make a systematic change with how we talk about, deal with, and implement mental well-being into policy.